Hepatitis B Vaccine: Indications, Action, Side Effects, and Contraindications – Dr Mahadeva Pokhale

The
hepatitis B vaccine is used to prevent hepatitis B infection, which can lead to
a wide variety of clinical presentations from acute viral hepatitis to chronic
liver failure, liver cirrhosis, and hepatocellular carcinoma (HCC).

In this
article, we’ll discuss the indications, action, side effects, and
contraindications of the hepatitis B vaccine for the prevention of hepatitis B
infection.

The
Hepatitis B vaccine received FDA approval in 1981, this recombinant version was
available in the market by 1986 that replaced the original blood-derived
vaccine. In 1991, the United States started a strategy to achieve universal
vaccination of infants beginning at birth for hepatitis B.

Hepatitis
B vaccination prevents active infection with the hepatitis B virus, which may
lead to chronic liver failure, cirrhosis & HCC. The virus is highly
infectious and can be transmitted through percutaneous or mucosal exposure to
blood and body fluids. The virus even remains viable on environmental surfaces
for more than seven days.

The vaccine is indicated in all infants and
unvaccinated children. This vaccine is also indicated in:

• Persons at
  risk for sexually transmitted disease
• Imprisoned
  personals.
• Persons
  whose sex partner is hepatitis B surface antigen (HBsAg) positive
• HBsAg
  positive household contacts
• Homosexual
  men.
• Intravenous
  drug users
• Healthcare
  workers, dialysis patients
• Persons
  with diabetes aged 19 to 59 years’ old
• Persons
  with hepatitis C
• Travelers
  to countries endemic for hepatitis B
• Persons
  with HIV
• Persons
  with chronic liver disease
• All
  persons seeking protection from hepatitis B

The
vaccine works by improving immunity by producing antibodies against the outer
protein coat or surface antigen by injecting a non-infectious subunit of the
virus.This protects an individual against all genotypes (A through H) of the
virus and gives a broad immunity.

The vaccine is administered in an
individual usually intramuscularly in deltoid muscle, as intradermal route of
administration is not preferred. The current regimen of three doses of the
recombinant vaccine over six months.

The
protection against infection initially was considered to be for 8 years. But
more recent research has confirmed ongoing immunity until 25 years in those
individuals who demonstrated a good immune response from the vaccine course.
But now it is considered as lifelong protection.

After
completing the three vaccination series, patients need a blood test for one to
four months to determine the immune response, which is defined as an
anti-hepatitis B surface antigen (anti-Hbs) antibody level exceeding 100mIU/mL.

The
immune response is not well-developed in a few patients such as patients with
age above 40 years, obesity, inflammatory bowel disease, tobacco smokers, or
alcoholics. In such patients, antibody levels between 10 and 100 mIU/mL are
suggestive of inadequate response; these patients should get a single booster
shot but do not require a retest.

Responses below 10 mIU/mL require additional
testing to check for prior hepatitis B infection, and these patients should
receive another three-dose regimen with testing again at the one to four-month
mark.

Continued failed response warrants may require more aggressive
interventions, including intradermal administration, high-dose vaccine, or
double dosing of a combination of hepatitis A and hepatitis B vaccine. Should
this fail, the patient will need hepatitis B immunoglobulin upon any exposure
to the hepatitis B virus.

The Advisory
Committee on Immunization Practices (ACIP) does not generally recommend titers
after vaccination, except for some healthcare workers and immunocompromised
persons.

Hepatitis
B vaccine is usually considered safe for individuals of all age groups. Other
than Some minor adverse effects like pain at the site of infection, fever, body ache. Few studies have shown that this vaccine increases sensitivity to
yeast.

Individuals should avoid taking
vaccines in case of any history of reaction to hypersensitivity after previous
hepatitis B vaccine dose or take with caution after having any previous
incidence of any hypersensitivity reaction to any other vaccine.

The vaccine contains a non-infectious surface
antigen, which poses no risk of transmission to the fetus and, therefore, is
safe in pregnancy.

The vaccine does not cause any toxicity, especially
with newer nanoparticle formulations.

To enhance the outcome of this vaccination regime is
to educate the general masses about the herd immunity effect, safety, need,
generally safe side effect profile, and the relatively few contraindications.

There is a need to increase the rate of vaccination by training the hospital
nursing staff to verify the patient’s vaccination status regarding hepatitis B
(as well as other vaccines) and report their findings to the clinician.
Motivational interviewing techniques have been shown to increase the rate of completion
of a vaccine regime.